4/29/2015 Dr. Carman Gill Wednesday, April 29th 1 4/29/2015 Impacted diagnoses Major changes and rationale Special considerations Implications for counselors A sustained condition of prolonged emotional dejection, sadness, and withdrawal A persistent affective state “colors a person’s perception of the world” (Reid & Wise, 1995, p. 145). Diagnosed when an individual’s depressed mood is prolonged enough to interfere with regular daily functioning (APA, 2013a; NIMH, 2012). 10% of the population High comorbidity with anxiety disorders 60% of clients diagnosed with MDD have symptoms related to Anxiety Disorders 2 4/29/2015 Stand alone chapter (previously part of mood) Chronic depression spectrum Removal of bereavement clause Clarifications to differentiate between depression and significant loss such as bereavement or financial devastation Addition of Disruptive Mood Dysregulation Disorder (DMDD) Dysthymic Disorder becomes Persistent Depressive Disorder Premenstrual Dysphoric Disorder (PMDD) Specifiers: with anxious distress; with mixed features 3 4/29/2015 The DSM-5 continues to use three groups of criteria to diagnose Depressive Disorders, 1) episodes 2) specific disorders 3) specifiers indicating the most recent episode and course Either depressed mood or loss of interest or pleasure plus four others for at least 2 weeks Coded by… Episodes- Single or Recurrent Severity-mild, moderate or severe Psychosis or remission noted 296.33 Major Depressive Disorder, recurrent episode, severe without psychotic features 4 4/29/2015 1) 2) 3) 4) 5) 6) 7) 8) With anxious distress With mixed features With melancholic features With atypical features With mood-congruent psychotic features or with mood-incongruent psychotic features With catatonia (code separately) With peripartum onset With seasonal pattern Same criteria No more bereavement clause exclusion Language to assist clinicians Note: Many people with chronic illness experience depression. In fact, depression is one of the most common complications of chronic illness. It is estimated that up to one-third of individuals with a serious medical condition experience symptoms of depression. 5 4/29/2015 Grief Feelings of loss/emptiness “pangs of grief” occurs in waves/decreases over time Positive emotional experience Thoughts of joining deceased Depression Persistent sadness/depressed mood Negative future thoughts/ selfcritical Lack of interest Worthlessness Suicidal ideation/plans New in response to the rise in children diagnosed with Bipolar Disorder (Blader & Carlson, 2007; Moreno et al., 2007) Between the ages of 6 and 18 with onset before the age of 10 Higher rates noted in males Displaying severe, non-episodic irritability with hyper arousal symptoms of mania but lacking well-demarcated periods of elevated or irritable mood characteristic of bipolar disorder. 6 4/29/2015 Marked by severe, recurrent outbursts of temper, either verbal or behavioral Significantly out of proportion in intensity and duration for circumstances and developmental stage The individual’s mood between temper outbursts is persistently irritable or angry. Averages at least three times per week for at least 12 months or more Behavior must be observable by others (e.g., parents, teachers, and/or peers) These behaviors must occur in at least two settings (e.g., school and home) and severe in at least one of these settings The individual cannot be free from severe recurrent temper outbursts for longer than three months (APA, 2013a). No history of mania or hypomania Cannot be explained by substance use, medication or medical condition or another mental disorder Must occur outside MDEs 7 4/29/2015 Rule outs MDD, behavior only occurs during an episode Bipolar supersedes (full manic or hypomanic episode) DMDD supersedes ODD Medical, substance, neurological In specific… DMDD has an underlying constant irritable mood, whereas ODD is intermittent and directed at authority and ADHD has the hallmark of inability to concentrate. No scientific explanation - theories include psychological trauma and abuse Poor family structure (recent death in the family, divorce, relocation) poor diet (lack of nutrition or vitamin deficiencies, underlying medical conditions) neurological disability that causes poor behavior, such as migraine headaches. 8 4/29/2015 In the DSM-IV-TR, Dysthymic Disorder Originally called Neurotic Depression (Sprock & Fredendall, 2008) PDD is a consolidation of chronic Major Depressive Disorder and Dysthymia Presents with depressed mood almost all day, more days than not (APA, 2013a) It is not uncommon for MDD to precede PDD, meaning that MDD symptoms may be continuously present for more than one year No longer excludes an MDE in the first two years of onset Exclusive to women Characterized by intense emotional and physical symptoms Occurring just prior to menses often continuing into menstruation (Daw, 2002). Originally “late luteal phase dysphoric disorder” in DSM-III-R Changed to Premenstrual Dysphoric Disorder in the DSM-IV (Cunningham, Yonkers, O’Brien & Eriksson, 2009) as “Depressive Disorder Not Otherwise Specified.” 9 4/29/2015 For most women, mild physical and emotional symptoms can occur, frequently referred to as PMS About 8% of menstruating women report symptoms distressing enough to cause impairment in daily functioning (Pilver, Desai, Kasl, & Levy, 2011) The symptoms must occur in most menstrual cycles the year before this diagnosis is given The individual must experience five symptoms including at least one of the following: (1) severe mood swings (affective lability) including feeling suddenly sad or tearful and/or becoming overly sensitive to rejection (2) increased interpersonal conflicts or significantly increased anger or irritability (3) feelings of hopelessness, self-critical thoughts, or distinctly depressed mood or (4) noticeable anxiety, tension, or feeling of edginess (APA, 2013a). 10 4/29/2015 Additional symptoms can include lack of interest in normal activities self-reported problems with concentration, fatigue or lack of energy changes in eating habits to include under or overeating and/or cravings sleep disturbance feeling of loss of control or being overwhelmed physical symptoms such as tenderness in the breasts, pain in the muscles or joints, swelling, bloating and/or weight gain (APA, 2013a) Confirmed by daily ratings during at least two symptomatic cycles. (Note: The diagnosis may be made provisionally prior to this confirmation) Clinically significant impairment in social, work, school or usual activities Cannot be related to substance use or medical issues Cannot be an exacerbation of another disorder Statistically, related to high levels of stress and being overweight These women are at least 60% more likely to have experienced physical or sexual abuse (Girdler, Leserman, Bunevicius, Klatzkin, Pedersen, & Light, 2007) 11 4/29/2015 Added for both MDD and Bipolar disorders Largely due to the high comorbidity Almost identical except… For MDD, the symptoms will be present most days of the Major Depressive episode For Bipolar, the symptoms will be present most days during manic or hypomanic episodes Two of the following symptoms are reported: 1. 2. 3. 4. 5. being keyed up or tense experiencing increased restless excessive worry that leads to difficulty concentrating irrational fear that something negative is about to occur fear of loss of self-control 2=mild, 3=moderate, 4-5=moderate-severe Severe= 4 or five with motor agitation 12 4/29/2015 Replaces mixed episode Depressive presentation predominant but some manic or hypomanic symptoms including elevated mood inflated self-esteem decreased need for sleep increase in energy or goal-directed activity. At least 3 must be present nearly every day during the most recent 2 weeks of the major depressive episode Removal of NOS - “Other specified” and “Unspecified” Disorders Rationale= overuse Other specified NOS Unspecified 13 4/29/2015 For technical questions [email protected] For content questions [email protected] May 6th Schizophrenia Spectrum Disorders Todd F. Lewis, Ph.D, LPC, NCC May 13th Assessment/Emerging Measure/Recording-Coding Casey A. Barrio Minton Ph.D May 20th Wrap Up/Bonus Session Stephanie F. Dailey, EdD, LPC, NCC, ACS 14